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NEWS

January/06/2007

Surgical treatment in paraplegia survey:

Cross-anastamosis in paraplegia below D9 started to give results. The last documented case operated 1 year ago in a patient from Israel came to the clinic 3 weeks ago. ECS and EMG performed showed that there is starting innervation of Th 11 and 12. The patient's lower limbs muscles became bulky and he could contract the lower abdominal muscles and some movements in the pelvic girdle. Crude sensation descended down to the inguinal level both sides. If you are more interested in this topic, click here! 

March/08/2007

Tuberculosis of the spine

In the last 2 years the incidence of tuberculosis of the spinal column is becoming more frequent and having different clinico-morphologic picture. This phenomenon is alarming sign as the residual of the use of dirty bombs and several radioactive materials in the surrounding dirty wars in the region. For demonstration click here! and here!

20-AUGUST-2007

SIEMENS Digital C-arm is implemented and functioning in the Shmaisani hospital.

30-AUGUST-2007

The Inomed ISIS Highline neurophysiologic navigation system start to work at the operating room.

28-November-2013

Magnetom Skyra 3 tesla with all clinical applications start to run.

 

 
 
 
 

1.  03-JUNE-2007  MUHAMED SALAMEH MUHAMED   21 YEARS  OLD CUT LEFT ULNAR NERVE AT THE DIVISION WITH RAMI DORSALIS.

 
 

 
 

Anamnesis

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The patient came to the clinic 27-May-2007 complaining of weak left hand with analgesia of the ulnar distribution same hand.

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The patient got cut wound by glass 2.5 years ago to the left forearm 4 cm above the wrist at the ulnar nerve trajectory.

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ECS done 22-May-2007 confirming complete non-function of the ulnar nerve above the division of the ramus dorsalis.

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On examination, there was complete analgesia of the ulnar distribution including the sensory branch of the ulnar nerve to the dorsum of the hand with atrophy of the interossii and the hypothenar mm. There is painful neuroma at the wound site.

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The ulnar nerve exposed above and below the neuroma. It was completely cut below the neuroma and the ramus dorsalis was involved with neuroma.

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The distal and proximal ends of the nerve were cut sharply after electrophysiological workup. The incision was made 45 degrees oblique and with good fascicles inside the epineurium. The gap was 3 cm length. Using 6 zero prolen, anastamosis was performed with 8 stitches with good adaptation under microscopic facilities.

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Closure of the wound and back-slap with slight flexion of the wrist was applied  for three weeks. 

Comments:

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The dorsal branch was sacrificed, because it has little clinical significance and it was in bad condition, that adequate reinnervation for it was less likely and could deform the good alignment of the direct anastamosis.

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Neurophysiologic studies must be performed during any such procedure in the nerves, even if it was clinically clear that complete cut of the nerve is present.

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The long time of the injury, play a negative role in the degree of recovery. Time will give the answer in such a case. But, considering the young age and the proximity of the injury to the target organs play a positive role in the outcome.

 
     
 

Copyright [2007] [CNS Clinic]. All rights reserved